White Matter Lesions Predict Recurrent Vascular Events in Patients with Transient Ischemic Attacks
Xiao-Mei Ren1, Shu-Wei Qiu2, Ren-Yuan Liu3, Wen-Bo Wu3, Yun Xu4, Hong Zhou5
1 Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu 210008; Department of Neurology, Yizheng People's Hospital, Yangzhou, Jiangsu 211400, China
2 Jiangsu Key Laboratory for Molecular Medicine, Nanjing, Jiangsu 210008, China
3 Department of Radiology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
4 Department of Neurology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University; Jiangsu Key Laboratory for Molecular Medicine; Department of Neurology, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu 210008, China
5 Department of Immunology, Nanjing Medical University, Nanjing, Jiangsu 211166, China
Dr. Hong Zhou
Department of Immunology, Nanjing Medical University, 101 Longmian Avenue, Nanjing, Jiangsu 211166
Source of Support: None, Conflict of Interest: None
Background: White matter lesions (WMLs) are common findings in brain magnetic resonance imaging (MRI) and are strongly associated with stroke incidence, recurrence, and prognosis. However, the relationship between WMLs and transient ischemic attacks (TIAs) is not well established. This study aimed to determine the clinical significance of WMLs in patients with TIA.
Methods: A total of 181 consecutive inpatients with first-ever TIA were enrolled. Brain MRIs within 2 days of symptom onset were used to measure WML volumes. Recurrent vascular events within 1 year of TIA onset were assessed. The relationship between WMLs and recurrent risk of vascular events was determined by a multivariate logistic regression.
Results: WMLs were identified in 104 patients (57.5%). Age and ratio of hypertension were significantly different between patients with and without WMLs. The incidence of vascular events in patients with WMLs significantly increased in comparison to those without WMLs (21.15% vs. 5.19%, 95% confidence interval [CI]: 1.18–15.20, P = 0.027) after controlling for confounders. Furthermore, distributions of WML loads were found to be different between patients who developed vascular events and those who did not. WML volumes were demonstrated to be correlated with recurrent risks, and the fourth quartile of WML volumes led to an 8.5-fold elevation of recurrent risk of vascular events compared with the first quartile (95% CI: 1.52–47.65, P = 0.015) after adjusting for hyperlipidemia.
Conclusion: WMLs occur frequently in patients with TIA and are associated with the high risk of recurrent vascular events, suggesting a predictive neuroimaging marker for TIA outcomes.